Minutes for Health in Hackney Scrutiny Commission meeting, Nov 10 2008, 7.00PM official page

1.1  Apologies for absence were received from Cllrs Jonathan McShane and Ian Rathbone.

1.2  Dean Henderson and Sarah Wilson from ELFT, Jacqui Harvey, Chief Executive CHtPCT, Lesley Mountford, Director of Public Health.

2.1  Urgent Item

The Chair explained the recruitment for co-opted member on the Health in Hackney Scrutiny Commission was completed.  It was noted a strong field of applications for the position of co-opted member was received which resulted in the recruitment panel appointing to all three co-opted member vacancy positions.

  The Chair informed the Commission the new co-opted Members recruited were approved at full council on 29^th October 2008 and were present at the meeting they are:

·  Joy Beishon

·  Clare Wykes

·  Sebastian Taylor.

  The Chair asked all attendees at the meeting to introduce themselves.

2.2  The Chair informed the Commission a host organisation for the Hackney had been appointed.  The Chair welcomed the representatives of the host organisation who addressed the Commission.  The host organisation was a voluntary sector group called Social Action for Health.  The representatives at the meeting was the Director, Elizabeth Bayliss and Deputy Director. Sharon Hanooman.  The Commission was updated with a brief progress of the progress in establishing the Hackney LINk.  Recruitment of the support staff for the LINk was progressing well with 2 administration staff in post and the project manager appointed with planned start date January 2009.  They reported progress on setting up the LINk steering group working towards elections and appointments to the steering group from February 2009 with the anticipated launch of the LINK by 1^st April 2009 and to date they have 12 members of the Hackney LINk.

2.3  Order of business was amended following the deletion of item 8 due to the officer presenting the information being off sick.

None

4.1  Minutes were approved subject to the following amendments:

Page 9 point 7.1.3 change met to meet.

Page 13 point 8.2.2 change from want to wants

Page 14 Rachel Gruber`s question stated ‘this service’ it should be amended to read ‘bariatric surgery’.  The Director of Nursing & Corporate Development from Homerton Hospital noted for clarification the question was referring to baratric surgery for adults not children highlighting the trust does not provide this service for children.

Page 10 point 7.1.4 to be amended to read…’This is work on Early Years Health promotion: physical activity, healthy eating, & emotional health and wellbeing; choices etc…’

Page 10 point 7.1.5 to be amended to read…’HAPPY in Hackney is an award…’

Page 11, last paragraph, penultimate line, should be ‘psychological’ instead of ‘physiological’ impact….’’

4.2  Matters Arising

4.2.1  Mrs Murgraff referred to page 2 and noted her dissatisfaction with the Commissions decisions at previous meeting in October 2008 to close the outstanding queries raised by the then PPIF about implementation of the Homerton Hospital’s Patient Visitors Policy.  Expressing that the trust had not offered the opportunity to meet with her to discuss the concerns raised.  The Director of Nursing for the Homerton Hospital advised that the Chair’s proposal to move forward was not to reflect a dismiss of the concerns raised by viewed as a clean slate to move forward starting with the scheduled review of the policy by the Commission in December 2008.  The Director of Nursing also offered to meet with Mrs Murgraff to discuss any concerns since the policy’s implementation on 1^st May 2008.

4.2.2  Mrs Murgraff referred to page 15 and enquired when the Commission was informed that the Transitional LINk did not wish to request for a co-opted member position.  The Overview and Scrutiny Officer advised the Members she had spoken to the Support Officer for the Transitional LINk to times and on both occasions she was informed the Transitional LINk had held a discussion at their meeting and agreed they did not wish to submit an application for a co-opted member’s position on the Commission.

RESOLVED

Minutes approved subject to the amendments stated above.

5.1  Presentation by Pauline Brown - Director of Nursing & Corporate Development from Homerton University Hospital NHS Foundation Trust.  The main points of the presentation were:

5.1.1  The trust’s service performance continues to improve. The Homerton Hospital received a double ‘Excellent’ rating for the quality of services and financial management for the annual health check 07/08.

5.1.2  The trust is monitoring and achieving on average waiting times of two weeks although this is slightly longer for specialist services.

5.1.3  They continue to have low levels of hospital acquired infections with the current total at 9 cases for MRSA as at the 10^th November 2008 (target is a maximum of 12 for the year) and 34 cases of C difficile (target of 59 for the year) year end is March 2009.  As six months of year remain action plans have been introduced.

5.1.4  Use of the Patient Experience Tracker has been extended, from the 10 units to 35, and is now available on all wards.  Information from this system is presented to the Board of Directors each month.

5.1.5  The 2 year partnership project ‘Reducing Infant Mortality Programme’ has been successful and success include more breast feeding, earlier booking and better attendance at antenatal care, fewer emergency admissions for new babies, and fewer women referring themselves too soon to labour ward.

5.1.6  In September the long awaited new fertility unit situated at the front of the hospital opened.

5.1.7  Change to provide single sex accommodation for surgical patients has been completed.  The trust continues to monitor their single sex bays very closely and any breaches (which are rare) are reported to the executive team.

5.1.8  An accident and emergency survey was published in September, this mainly focused on the PCT out of hours service provision.  Scores relating to the Homerton Hospital A&E department were positive and the concerns raised were largely attributed to parking facilities.

5.1.9  The Trust has reported a financial surplus of £3.2 million as at the end of September 2008.

5.2  Questions and Answers

Cllr Middleton made reference to NHS implementing a national IT system that would enable access to patient records across the country seeking clarification on when this national IT system would be available for patient history.

The Director of Nursing from the Homerton Hospital explained the national IT system was a big development that would take time before it could be implemented and an IT development of this size would come in time hopefully within the next few years.

The trust has implemented an electronic data system for patient records and reflected connections with GPs needed to be improved and that the trusts did not operate an electronic prescribing system.  It was highlighted the IT improvements the trust made are shared with the NHS national project so lessons could be learnt. 

The Chair enquired how the trust planned to respond to the Department of Health letter in relation to deep cleaning.

The Director of Nursing explained the trust recognised the importance of the deep  ...  view the full minutes text for item 5.

6.1  Presentation by Dr Sharon Lewis - Chartered Clinical Psychologist from City and Hackney Primary Care Trust (CHTPCT) Child and Adolescent Mental Health Services (CAMHS) – tackling obesity project; also in attendance was Sherbanu Sacoor Head of Service PCT CAMHS and LBH / CHtPCT Head of Healthy Communities David Woodhead.  The main points of the presentation were:

6.1.1  Childhood obesity is likely to involve complex and interacting factors.

Environmental factors related to obesity are:

·  Nutrition: types of food available/provided

·  Eating behaviour

·  Physical (in)activity.

6.1.2  Current strategies being targeted at:

·  propose behavioural strategies

·  propose changes in exercise habits

·  propose changes in eating habits

6.1.3  It was expressed that none of these strategies had particularly been effective in reversing the process of obesity for adults or children.

6.1.4  People are living in an obesogenic modern environment but it was expressed that people encountered obesogenic early programming of their brain.

6.1.5  For some overweight children (not all) emotional factors was a component in their weight problem.

6.1.6  It was proposed that overweight/obesity in children was linked to poor parenting strategies.

6.1.7  It was considered that psychological difficulties probably lead to obesity through maladaptive defence mechanisms such as:

·  ignoring & dismissing feelings

·  neglecting mental and physical health

·  (self) destructive/putting self into dangerous and unhealthy situations

·  Devaluing self.

6.1.8  It was expressed that repressed feelings caused by early life trauma (unbearable feelings) cause anxiety and could lead to maladaptive defences.

6.1.9  Lasting solutions to obesity must address the interface of reality (practicality) with unconscious conflicts.

6.1.10  Parenting skills (or lack thereof) was felt to be directly linked to childhood obesity.

6.1.11  Posing questions like:

·  How was it possible to watch your child grow obese and not notice or not take action?

·  Why did some parents not have control over their child’s eating habits?

6.1.12  If there were problems around eating it was considered there was likely to be problems in other areas of parenting.

6.1.13  It was explored that children who are overweight probably had emotional or behavioural difficulties if not the cause, then as a consequence.

6.1.14  Practical steps that parents could take are:

·  In infancy – breastfeeding is a safeguard against obesity

·  Toddlers need opportunities to try new foods without being forced to eat them; and need to be allowed to stop eating when they are full.

·  Making nutritious foods available at home

·  Encouraging family mealtimes

·  Incorporating physical activity into daily routines

·  Limiting television viewing and other sedentary activities

·  Serving as positive role models by modelling healthy lifestyles – eating behaviours, physical activity, self-care.

6.1.15 Although it was important to consider what children eat it was expressed of equal importance was how the child ate. This is influenced by a number of factors such as:

·  family eating patterns, and whether meals are shared or eaten alone

·  parents’ control over the child’s eating habits restriction and monitoring what is eaten

·  ...  view the full minutes text for item 6.

7.1  Presentation by Cllr Vincent Stops ward Councillor for Hackney Central presenting information about obesity trends, NICE guidance on physical activity and the environment and what it means for Hackney.  The main points of the presentation were:

7.1.1  The presentation showed the visible changes of obesity trends in the United States of America.  In 1985 it showed approximately 22 states reported not data on obesity this gradually increased resulting in 2007 all states reporting not less than 10% having a BMI >30 or 30lbs overweight and 4-5 states reporting 25-29% with BMI >30 or 30lbs overweight.

7.1.2  The NICE guidance made reference to transportation and the need to health design cities for active mobility.

7.1.3  Trends from the Department of Transport showed Londoners are walking slightly less than they used to ten years ago.

7.1.4  Although cycling had increased with the implementation of the congestion charge.  More cyclists were needed to improve cycling conditions.

7.1.5  It was expressed there needed to be a willingness to put constraints on vehicle traffic which is difficult to implement but important and good for the community.

7.1.6  Cities need to be designed around walking and cycling.  Designing cities like this will increase social interaction among people and recreation whereby the presence of other people are the special attraction.  Producing a traffic environment more calm and friendly and making the crossing of streets safer.

7.1.7  Copenhagen from 1995-2005 increased cycling 100% to have 36% cycling to work on a bicycle, 23% using the car and 33% using public transport.

7.1.8  Various pictures where shown of the changes made to cities showing the before and after of cities that changed.

7.1.9  Ms Rocke-Caton commented that people were afraid to ride bikes due the lack of provision for cyclist and also highlighted there was an increased number of buses available for people so less of a need to walk.

7.2  Questions and Answers

Mrs Murgraff enquired if the transport department could encourage planning to reduce the number of developments agreed with garage / parking facilities for vehicles.

Cllr Stops advised LBH Planning did approve non car parking schemes and encouraged these developments.

Co-opted member Ms Wykes enquired if it was known how many children within the borough went to their local school and could walk there?

Cllr Stops acknowledged a number of children went to school outside the borough or may have a longer distance to travel, but commented that previously approximately 90% of children used to travel to school alone now approximately only 8% travel on their own.

Cllr Middleton commented that if the reduction in vehicles was made how the provision of roads would be financed; as bikes were not taxed and insured like vehicles to contribute towards the cost of road maintenance.

The Chair enquired if LBH was doing enough to encourage more cycling.

Cllr Stops advised LBH was adhering to the London Plan and the provision of safe cycling routes was the responsibility of transport not planning.  Through his presentation he aimed  ...  view the full minutes text for item 7.

This item was deleted from the meeting discussion due to the officer presenting the information being off sick.

9.1  Presentation by Ray Boyce LBH Chief Officer of Transformation, Community Services also in attendance was Janice Wightman the Assistant Director for Adult Social Care.  The main points of the presentation were:

9.1.1  It is a national requirement for Local Authorities to redesign their social care system to be able to respond to the demographic challenges being presented by an aging population and raising expectations of social care provision for quality of life.  A journey of transformation.

9.1.2  The public views when consulted were that they did not like the service currently provided.  The following desires were expressed:

·  Access to support when we need it, available quickly, easily and to fit into our lives.

·  Create focus on using preventative approaches to promote independence and well being.

·  Emphasis on enablement and early intervention

·  More choice, control and power and support to plan their own lives.

·  To shape their own menu of support.

9.1.3  The LBH choice is to adopt a personalised service approach.

9.1.4  This would mean that care is bespoke, tailor made to individual needs, anticipated to offer access to universal services so that the person could live in dignity, with independence and choice.

9.1.5  After the assessment is carried out the person would know the amount of funding resource available to them and could manage their own budget and spend it on the care services they desire. 

9.1.6  A DVD was played showing an example of how a person using this type of service felt about managing their own care services.

9.1.7  This proposed service provision had been piloted and an evaluation from the pilot revealed people receiving an Individual Budget (IB) reported feeling significantly more in control of their daily lives.  Welcoming the support obtained and how it was delivered, compared to those receiving conventional social care services.  However, it was highlighted there were differences between groups.

9.1.8  Some comments from service user groups noted:

·  Mental health service users reported significantly higher quality of life;

·  Physically disabled adults reported receiving higher quality care and were more satisfied with the help they received;

·  People with learning disabilities were more likely to feel they had control over their daily lives;

·  However older people were less enthusiastic about using this option and reported lower psychological well-being with IBs, perhaps because using this type of service provision meant the person became an employer and it was considered it could be too much of a burden.

9.1.9  To see LBH through these changes Community Services has set up a Transformation of Adult Social Care Board (TRASC).

9.1.10  Key projects set up under the project board are:

·  Self Assessment/Resource Allocation System/Support Planning

·  Prevention/Well Being Strategy – being developed

·  Supported Housing with Care - The success of LBH supported living schemes has been recognised and starting in 2009 LBH Community Services will have a target of opening 30 new units.  

·  Development of Telecare/Telehealth

·  Workforce development & leadership.

9.2  Questions and  ...  view the full minutes text for item 9.

10.1  The Chair referred to the report attached under item 10 and explained it was a report from NHS London in response to the report of the Joint Overview and Scrutiny Committee for the HfL stage 1 consultation.  To be noted for information.

10.2  Questions and Answers

Mr McCabe made an inquiry; if a member of the public had written to the Chair of the Commission (HiH) could they expect a response.

The Chair confirmed a person could usually expect a reply.

Mr McCabe advised he had written to the Chair of the Health Scrutiny Commission and enquired why he had not received a response.

The Chair explained if a Councillor received an inquiry they could choose to pass the query to the ward councillor of the resident or handle the query as part of their case work, but noted he could not advise what method the Councillor in question had chosen as he was not present at the meeting or aware of this correspondence.

Mr McCabe highlighted that his inquiry was directed to the Councillor in his capacity as Chair of the Commission not as a ward Councillor and expected the matter to be an issue for HiH.

The Chair noted an inquiry may not necessarily be included on the Commission’s work plan and the Councillor could choose to resolve the matter independently as part of his case work unless he considered the issue to be vexatious.  He reiterated he could not provide any further information related to this matter as the Councillor in question was not present at the meeting to respond.

Mr McCabe expressed dissatisfaction with the Chair’s response and use of the word vexatious and the response he had received from the O&S Officer when he made an enquiry as to why the Chair of HiH had not responded to his written correspondence.  Stating if members of the public could not express their concerns with HiH about heath service provision and expect a response how could residents interact with HiH.

The Chair declared the meeting over as it had become inquorate.